R Bacon Enterprises Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

FDA1835621 Issued in IN

Legal business name

R BACON ENTERPRISES INC

Doing business as

Freedom Medical Boonville Medical

Practice address

966 N Baker Rd
Boonville, IN 47601-9509

Phone

(812) 897-1904

Fax

(812) 897-0620

NPI assigned

Feb 9, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Karen A Bacon

Title

Vice President

Phone

(812) 897-1904

Specialties & licenses 1

Addresses

Other identifiers 11

Other names 1

• Freedom Medical Boonville Medical Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922071984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "966 N BAKER RD",
            "city": "BOONVILLE",
            "state": "IN",
            "postal_code": "476019509",
            "telephone_number": "812-897-1904",
            "fax_number": "812-897-0620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "966 N BAKER RD",
            "city": "BOONVILLE",
            "state": "IN",
            "postal_code": "476019509",
            "telephone_number": "812-897-1904",
            "fax_number": "812-897-0620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R BACON ENTERPRISES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BACON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "812-897-1904",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IN",
            "license": "FDA1835621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000193509",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "8200169",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000097303",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000193499",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARMONY HEALTH PLAN",
            "identifier": "286867",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000107530",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90009473",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000335185",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACM",
            "identifier": "1023713",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000335186",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "0742058",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Freedom Medical Boonville Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Boonville, IN
• Providers in Boonville, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.